PolicyLab

Here’s a pop quiz: what’s one thing that the University of Missouri, SUNY New Paltz and Tufts University all have in common?

The answer: they’ve all recently faced outbreaks of mumps on campus.

As the PolicyLab Goes Back to School blog post series has well documented, a child’s educational attainment and their health are inextricably linked. College students in particular face a unique set of circumstances that can impact their health; for the first time ever, many of these youth are responsible for financially supporting themselves, and the caliber of their academic coursework is more demanding than it was in high school. The stress resulting from these new experiences, as well as its adverse consequences such as sleep loss, has the potential to exasperate or precipitate both mental and physical health conditions.

That is why prevention really matters for college students. One important prevention tool that we may not always think about for this age group is vaccination. While vaccines cannot improve all conditions that youth face on college campuses, they still prevent a number of key health conditions, including mumps, the flu and meningitis. Colleges play an important role in promoting vaccine uptake amongst their students, both in the availability of these services at their student health centers and in establishing requirements that may impact students’ eligibility to enroll in classes or live in campus housing.

College campuses have legitimate incentive to ensure that their students are properly vaccinated; recent mumps outbreaks on campuses like the ones above have demonstrated that the crowded environment in classrooms and dormitories, as well as social activities, facilitate the spread of disease in ways that may not happen in other environments. The costs associated with disease outbreaks negatively impact the health of the student body and impede student success.

As a specialist in infectious disease, I have a particular interest in understanding immunization policies on campus and how they may influence the number of students who are vaccinated. Along with a team of researchers at Children’s Hospital of Philadelphia, I’ve taken a deep dive into immunization policies at colleges and universities nationwide using data collected from student health centers’ websites. In total, we surveyed more than 200 institutions in every state and Washington, D.C., ranging from small liberal arts colleges on the East Coast to large state universities in the Midwest. We looked at a few key outcomes of interest, including the type and number of vaccines each institution required and recommended, the stringency with which they enforced those requirements and which vaccines were supplied through student health centers.

The results gave us a fairly comprehensive picture of how institutional policies around immunization vary across college campuses.

Vaccines Required and Recommended

Out of all of the surveyed schools, 94 percent required at least one vaccine to enroll in classes. Institutions most frequently required the measles, mumps and rubella (MMR) vaccine (88.4 percent) followed by the quadrivalent meningococcal vaccine (MCV4) (51.9 percent). Interestingly, no schools required the influenza or human papillomavirus (HPV) vaccines.

Furthermore, all schools required vaccines that states also included in their immunization requirements, but the majority (65.3 percent) required additional vaccines to address the needs of their campus community.

While the reason for this finding is not clear, we found a relationship between the region that a school is in with their required vaccines and enforcement strategies. For example, schools in the Midwest and West were significantly more likely to have fewer vaccine requirements than schools in the South. We did not find such a relationship for other school factors, such as the size of the school or presence of an accredited school health center.

Enforcement Strategies

Schools used a range of enforcement strategies to ensure compliance with vaccination requirements. The most common strategy we observed was barring students from registering for classes by placing a hold on their account (67.1 percent) until they received required vaccines. The second most common strategy was a restriction on moving into on-campus housing (14.8 percent).

Vaccines Supplied Through Student Health Centers

Another key component of our analysis was whether schools supplied vaccines through their student health centers. According to information available on the websites we reviewed, nearly 14 percent of the schools did not offer a single vaccine at their student health center. Only about 56 percent offered the influenza vaccine, which the Center for Disease Control and Prevention recommends for all individuals older than 6 months old every year, while other vaccines like Hepatitis B, MMR and meningococcal were all offered at more than 65 percent of schools.

These findings show that while vaccines are an important prevention tool for college students, there is significant variation in the way that colleges and universities approach immunization requirements and the availability of immunization services.  If recommended vaccines are not consistently accessible to students, this could affect their utilization and subsequent impact on preventing disease outbreaks. Considering that many youth may not have other opportunities to receive preventive health services, student health centers may be one of their only options for learning about and accessing vaccines. To better understand this variability and the potential impact on immunization rates among college students, our team is now completing interviews with students and student health administrators.  We hope to use these additional results to identify best practices for college vaccine policies to ensure that all students receive vaccines recommended for their age group.

Vaccines are a powerful, cost-effective tool for preventing the spread of disease and ensuring that adolescents have the opportunity to thrive on campus. As our young people head back to school, my hope is that colleges and universities around the country recognize their value and work to ensure that their policies effectively promote vaccination for a safe and healthy campus community.